Karen Horney (1885–1952), a pioneering German-born neo-Freudian psychoanalyst, understood the relationship between motivation and psychopathology as rooted not primarily in instinctual drives proposed by Sigmund Freud (1856–1939), but in the individual's efforts to cope with anxiety generated by disturbed interpersonal relationships, particularly during childhood.

In works such as The Neurotic Personality of Our Time (1937) and Neurosis and Human Growth (1950), Horney argued that a lack of genuine love, security, and acceptance from caregivers produces basic anxiety, which motivates the development of neurotic coping strategies characterised by moving towards, against, or away from people. These defensive patterns, although initially adaptive, become rigid and compulsive, leading to psychopathology by alienating individuals from their "real self" and fostering an unrealistic "idealised self." Horney's theory shifted emphasis from biological determinism to social, cultural, and relational influences on personality development and psychological disturbance, influencing later humanistic and interpersonal approaches to psychotherapy.

From a Christian perspective, Horney's recognition of the importance of love, relationships, and authentic personhood resonates with Biblical teachings that humans are created in the image of God (imago Dei; Genesis 1:26–27), are designed for loving relationships (Matthew 22:37–39), and flourish within secure, truthful fellowship (Ephesians 4:15–16). However, Christianity differs from Horney by locating the deepest source of human brokenness not merely in interpersonal anxiety but in humanity's fallen condition and separation from God through sin (Romans 3:23; Genesis 3). Christian theology therefore sees lasting healing as requiring not only psychological insight and healthier relationships but also reconciliation with God through Jesus Christ (2 Corinthians 5:17–21), whose perfect love "drives out fear" (1 John 4:18). Thus, while Horney's emphasis on relational security offers valuable psychological insights, a Biblical worldview interprets human motivation and psychopathology within the broader theological framework of creation, fall, redemption, and restoration.

Horney made an important contribution to understanding personal life strategies by arguing that individuals develop enduring cognitive and behavioural patterns in response to experiences of insecurity, particularly basic anxiety, which, as we have seen, arises from disturbed interpersonal relationships during childhood (Horney, 1937, 1945, 1950). Rather than viewing personality primarily as the product of instinctual drives, Horney proposed that people adopt characteristic strategies for navigating perceived threats and opportunities through three dominant orientations: moving toward people (seeking safety through compliance and approval), moving against people (pursuing security through power, control, and competition), and moving away from people (seeking protection through emotional withdrawal and self-sufficiency). These enduring orientations function as cognitive and behavioural life strategies that shape how individuals interpret their social world, regulate emotions, pursue goals, and respond to challenges. Her work is therefore highly relevant to the concept of life strategy because it explains how adaptive attempts to cope with anxiety may become rigid personality patterns that influence decision-making and relationships throughout adulthood.

Horney's recognition that fear and insecurity profoundly influence human behaviour resonates with the Biblical portrayal of humanity's vulnerability after the Fall (Genesis 3:7–10) and the pervasive effects of fear and disordered desires. However, Christian theology would critique Horney's essentially humanistic confidence that psychological insight and healthier relationships are sufficient for lasting transformation, arguing instead that genuine renewal requires reconciliation with God through Christ and the sanctifying work of the Holy Spirit (Romans 12:2; 2 Corinthians 5:17; Galatians 5:22–23). Scripture consistently presents wisdom, trust in God, and conformity to Christ, rather than anxiety-driven self-protection, as the foundation of a flourishing life strategy (Proverbs 3:5–6; Matthew 6:25–34; Philippians 4:6–9), while theologians such as Augustine of Hippo and John Calvin likewise emphasised that the human heart finds its proper orientation only when ordered toward God rather than toward self-preservation or self-sufficiency.